K. Osann

Ovarian cancer in younger vs older women: a population-based analysis

To compare the clinico-pathologic prognostic factors and survival of younger vs older women diagnosed with epithelial ovarian cancer. Demographic, clinico-pathologic, treatment, and surgery information were obtained from patients with ovarian cancer from the Surveillance, Epidemiology, and End Results Program from 1988 to 2001 and analysed using Kaplan–Meier estimates. Of 28 165 patients, 400 were <30 years (very young), 11 601 were 30–60 (young), and 16 164 were >60 (older) years of age. Of the very young, young, and older patients, 261 (65.3%), 4664 (40.2%), and 3643 (22.5%) had stage I–II disease, respectively (P<0.001). Across all stages, very young women had a significant survival advantage over the young and older groups with 5-year disease-specific survival estimates at 78.8% vs 58.8 and 35.3%, respectively (P<0.001). This survival difference between the age groups persists even after adjusting for race, stage, grade, and surgical treatment. Reproductive age (16–40 years) women with stage I–II epithelial ovarian cancer who received uterine-sparing procedures had similar survivals compared to those who underwent standard surgery (93.3% vs 91.5%, P=0.26). Younger women with epithelial ovarian cancer have a survival advantage compared to older patients.

The potential therapeutic role of lymph node resection in epithelial ovarian cancer: a study of 13 918 patients

The aim of the study is to determine the role of lymphadenectomy in advanced epithelial ovarian cancer. The data were obtained from the Surveillance, Epidemiology and End Results (SEER) program reported between 1988 and 2001. Kaplan–Meier estimates and Cox proportional hazards regression models were used for analysis. Of 13 918 women with stage III–IV epithelial ovarian cancer (median age: 64 years), 87.9% were Caucasian, 5.6% African Americans, and 4.4% Asians. A total of 4260 (30.6%) underwent lymph node dissections with a median number of six nodes reported. For all patients, a more extensive lymph node dissection (0, 1, 2–5, 6–10, 11–20, and >20 nodes) was associated with an improved 5-year disease-specific survival of 26.1, 35.2, 42.6, 48.4, 47.5, and 47.8%, respectively (P<0.001). Of the stage IIIC patients with nodal metastases, the extent of nodal resection (1, 2–5, 6–10, 11–20, and >20 nodes) was associated with improved survivals of 36.9, 45.0, 47.8, 48.7, and 51.1%, respectively (P=0.023). On multivariate analysis, the extent of lymph node dissection and number of positive nodes were significant independent prognosticators after adjusting for age, year at diagnosis, stage, and grade of disease. The extent of lymphadenectomy is associated with an improved disease-specific survival of women with advanced epithelial ovarian cancer.

In vitro comparison of a novel facilitated ultrasound targeting technology vs standard technique for percutaneous renal biopsy.

OBJECTIVE To improve the understanding of the epidemiology of renal cortical neoplasms through pretreatment biopsy, we evaluated a facilitated ultrasound targeting (FUT) technology. The technology allows a needle to be passed through the transducer probe and guided along a virtual dotted line on the monitor. We compared the FUT with standard percutaneous biopsy (PB) technique. MATERIALS AND METHODS Forty-eight participants with various levels of training were recruited. Participants performed ultrasound-guided biopsies on phantom models using FUT and the standard biopsy technique in a randomized sequence. The phantom models consisted of pimento olives embedded in an opaque mold of Metamucil and Knox gelatin. Patients were given up to 10 attempts to achieve 3 complete specimens from the olives. Patients rated each biopsy technique. Results were stratified by level of experience. RESULTS The mean time to obtain 3 complete biopsy specimens was significantly faster for FUT compared with the standard technique (140 seconds vs 246 seconds, P = .0001). The mean number of attempts needed to obtain 3 specimens was significantly less with FUT compared with the standard technique (4.3 vs 5.6 attempts, P = .0007). Patients reported that FUT was significantly easier to use compared with the standard technique (P = .0005). No significant order effect was observed. CONCLUSION In this in vitro comparison, FUT increased the efficiency and efficacy of PB for users of all experience levels. FUT may allow urologists with limited PB experience to perform the procedure reliably and easily. Clinical evaluation of this technology is actively in progress.

Tracking and assessment of technical skills acquisition among urology residents for open, laparoscopic, and robotic skills over 4 years: is there a trend?

BACKGROUND AND PURPOSE Tracking the progression of technical skill acquisition during urology residency training is an essential yet challenging task that has been mostly based on anecdotal and subjective performance assessment. We evaluated five surgical tasks used at our institution to assess skill acquisition among residents over 4 consecutive years in an effort to determine appropriate skill testing for resident proficiency relative to level of training for future performance testing. METHODS Urology residents were tested yearly throughout the course of their residency with five surgical tasks in an open, laparoscopic, and robotic format. The five tasks were: (1) rings on a peg, (2) thread the rings, (3) cut the line, (4) hexagonal suturing, and (5) suture and knot tying. Evaluation was performed by a trained instructor to assess quantity and quality of the skill task performance. RESULTS The highest scores were obtained on all open tasks regardless of training level. Residents performed second best on robotic and lowest on the laparoscopic skill tasks. The score difference among surgery platforms was statistically significant P<0.0005 across all tasks. It was Tasks 2 and 5, however, that showed a statistically significant difference in overall quantity×quality score between different postgraduate year (PGY) residents (P=0.03 and P=0.02). In addition, the quantity score for Task 5 also showed a statistically significant difference among PGY residents (P=0.04). There was no statistically significant difference in time to perform tasks among PG years. CONCLUSIONS The high-level Tasks 2 and 5 were the most useful in differentiating different levels of skill task competency among urology residents and appear to be most useful in assessing the degree of improvement among residents during training. These tasks have subsequently been worked into our institutions testing curriculum.

Superiority of cyclosporin A over PSC-833 in enhancement of VP-16 efficacy in murine tumors in vivo.

Abstract PSC-833, a non immunosuppressive analogue of cyclosporin A, is an effective modulator of the multidrug-resistant tumor phenotype. Since both PSC-833 and cyclosporin A also enhance the cytotoxicity of VP-16 against drug sensitive L1210 leukemia cells in vitro we compared these agents as modulators of VP-16 efficacy in vivo. Compared to VP-16 treatment alone both PSC-833 and cyclosporin A significantly altered the survival of L1210 leukemia-bearing BDF/1 mice and Lewis lung carcinoma-bearing C57/Bl mice. Cyclosporin A enhanced VP-16 efficacy whereas PSC-833 impaired VP-16 efficacy against these murine tumors. Possible reasons for these disparate effects are discussed.

MP25-13 PROSPECTIVE ANALYSIS OF ACCESSORY PUDENDAL ARTERY TRANSECTION ON POTENCY DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY (RARP)

both the pre(HR 1.43, 95% CI 1.08-1.88, p1⁄40.013) and post-antibiotic impregnated (HR 1.69, 95% CI 1.19-2.41, p1⁄40.004) eras. CONCLUSIONS: Our analysis strongly supports the notion that DM is a risk factor for IPP infection. In the contemporary era of antibiotic-impregnated devices, IPP recipients with DM are at 1.7-fold increased risk of infection compared with non-diabetic men. This has important implications for patient selection and counseling, and raises the question of whether this increased risk can be mitigated by optimization of glycemic control prior to surgery.

Consensus in controversy: The modified Delphi method applied to Gynecologic Oncology practice - eScholarship

OBJECTIVES To determine the degree of consensus regarding the probabilities of outcomes associated with IP/IV and IV chemotherapy. METHODS A survey was administered to an expert panel using the Delphi method. Ten ovarian cancer experts were asked to estimate outcomes for patients receiving IP/IV or IV chemotherapy. The clinical estimates were: 1) probability of completing six cycles of chemotherapy, 2) probability of surviving five years, 3) median survival, and 4) probability of ER/hospital visits during treatment. Estimates for two patients, one with a low comorbidity index (patient 1) and the other with a moderate index (patient 2), were included. The survey was administered in three rounds, and panelists could revise their subsequent responses based on review of the anonymous opinions of their peers. RESULTS The ranges were smaller for IV compared with IP/IV therapy. Ranges decreased with each round. Consensus converged around outcomes related to IP/IV chemotherapy for: 1) completion of 6 cycles of therapy (type 1 patient, 62%, type 2 patient, 43%); 2) percentage of patients surviving 5 years (type 1 patient, 66%, type 2 patient, 47%); and 3) median survival (type 1 patient, 83 months, type 2 patient, 58 months). The group required three rounds to achieve consensus on the probabilities of ER/hospital visits (type 1 patient, 24%, type 2 patient, 35%). CONCLUSIONS Initial estimates of survival and adverse events associated with IP/IV chemotherapy differ among experts. The Delphi process works to build consensus and may be a pragmatic tool to inform patients of their expected outcomes.

Characteristics and outcomes of pharmaceutical versus nonpharmaceutical affiliated phase III clinical trials on targeted agents for cancer therapy.

5073 Background: To compare the characteristics and outcomes of phase III clinical trials with or without pharmaceutical affiliation on targeted agent for cancer therapy. Methods: All phase III clinical trials using targeted agents in advanced cancers were identified in PubMed, Cochrane Central Register of Controlled Trials from 1986 to 2006. Chi-squared test and logistic regression analyses were employed for statistical analyses. Results: Of 159 phase III trials, 49 were affiliated with pharmaceutical institutions and 110 were from academic institutions, research institutes or cooperative groups. In the overall study, 82 trials were biologic vs. 77 trials were combination biologic and chemotherapy. 15 (9.4%) clinical trials were from single institutions vs. 143 (89.9%) from multiple institutions. 57 (35.8%) phase III trials were from the United States, 54 (34.0%) Europe, and 48 (30.2%) were from other countries including those from Asia and Australia. Pharmaceutical-affiliated trials enrolled a higher nu...

Cancer screening distress in a clinic-based population of BRCA mutation carriers

20570 Background: Knowledge of BRCA1/2 carrier status has been linked with increased distress and health concerns in this population. Mutation carriers receive recommendations for more intensive cancer screening, which may create added stress. The purpose of this study is to identify whether there are differences in distress associated with the screening process depending on completion of prophylactic surgery (PS), and to determine whether this distress changes over time. Methods: A longitudinal design was utilized to survey 90 physician-referred women who had previously received notice that they were BRCA1/2 mutation carriers. Patient-reported surveys were collected during the first clinic visit, and at one year follow-up for 55 women. Cancer screening distress was measured by the Impact of Event Scale. Statistical analyses included t-tests and analyses of variance for continuous variables, and chi-square tests for categorical variables. Results: Among 90 BRCA1 (69%) or BRCA2 (30%) carriers, 40% had a ca...

Older patients with germ cell cancer of the ovary

16588 Background: To determine prognostic factors and survival of older (>40 years) patients with germ cell ovarian cancer. Methods: Demographic, clinico-pathologic, treatment and surgery information were obtained on all patients with invasive ovarian carcinoma registered in the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute between 1988 and 2001. Patients were divided into two groups: those diagnosed at age 40 years or less and >40 years old. Survival data were analyzed using Kaplan-Meier estimates. Results: Of 778 women diagnosed with germ cell cancer of the ovary, 77 were older than 40 years with a median age of 50 years. 701 women 40 years or less were used as controls; with a median age was 22 years. Older patients, greater than 40 years, had significantly more advanced stage cancers (stage III-IV) compared to the younger cohort (44.2% vs. 21.6%; p<0.001). Furthermore, the proportion of grade 3 tumors was significantly higher in the older cohort (28.6% vs. ...